outcomes personal pharmacist ™ training module/encounter™ mtm case examples
TRANSCRIPT
Outcomes Personal Pharmacist™ Training
Module/Encounter™ MTM Case Examples
Case Example #1 A 45 year old female, presented to a pharmacy with a
prescription for a sulfa antibiotic (Drug A).
The pharmacist reviewed her drug history and found a notation that she is allergic to sulfas. The previous reaction was anaphylaxis. The pharmacist contacted the physician recommending a switch to an alternative medication (Drug B). The physician was not aware of the patient’s history and agreed with the pharmacist’s recommendation.
The pharmacist filled the new prescription for the alternative medication and properly educated the patient. Upon follow-up the pharmacist learned that the patient’s infection had resolved after a full course of therapy.
Case Example #1: Question 1
How many Encounter claims should be filed as a result of Case Example #1?
One Two Three Four
Case Example #1: Question 2
What is the Reason for the first claim? Needs Therapy Suboptimal Drug Selection Adverse Drug Reaction Other
Case Example #1: Question 3
What is the Action for the first claim? Comprehensive Medication
Review (CMR) Prescriber Consultation Patient Education/Monitoring Patient Compliance Consultation
Case Example #1: Question 4
What is the Result for the first claim? Therapeutic Success Initiated New Therapy Changed Drug Altered Regimen/Changed Drug
Case Example #1: Question 5 What is the initial prescription
information for the first claim? The sulfa the patient took previously which
caused an anaphylactic reaction The alternate antibiotic (Drug B)
recommended by the pharmacist The antibiotic (Drug A) originally
prescribed by the doctor There is no initial prescription information
Case Example #1: Question 6 What is the final prescription
information for the first claim? The sulfa the patient took
previously which caused an anaphylactic reaction
The antibiotic (Drug B) recommended by the pharmacist
The antibiotic (Drug A) originally prescribed by the doctor
There is no final prescription information
Case Example #1: Question 7
What is the frequency of therapy for the first claim? Acute Intermittent Chronic You do not need to select a
frequency of therapy
Case Example #1: Question 8
What is the ECA for the first claim? Level 1: Improved Quality of
Care Level 3: Additional Prescription
Order See Previous Claim Level 7: Life Threatening
Case Example #1: Question 9
What should be included in the note of the first claim? Description of the education and
monitoring Description of the intervention Justification for the ECA selected B & C
Case Example #1: Question 10
What is the Reason for the second claim? New/Changed Prescription Therapy Suboptimal Drug Selection Adverse Drug Reaction Other
Case Example #1: Question 11
What is the Action for the second claim? Comprehensive Medication Review
(CMR) Prescriber Consultation Patient Education/Monitoring Patient Compliance Consultation
Case Example #1: Question 12
What is the Result for the second claim?
Therapeutic Success Initiated New Therapy Changed Drug Altered Regimen/Changed Drug
Case Example #1: Question 13
What is the initial prescription information for the second claim? The sulfa the patient took previously
which caused an anaphylactic reaction The alternate antibiotic (Drug B)
recommended by the pharmacist The antibiotic (Drug A) originally
prescribed by the doctor There is no initial prescription information
Case Example #1: Question 14
What is the final prescription information for the second claim? The sulfa the patient took previously
which caused an anaphylactic reaction The antibiotic (Drug B) recommended by
the pharmacist The antibiotic (Drug A) originally
prescribed by the doctor There is no final prescription information
Case Example #1: Question 15
What is the frequency of therapy for the second claim? Acute Intermittent Chronic You do not need to select a
frequency of therapy
Case Example #1: Question 16
What is the ECA for the second claim? Level 1: Improved Quality of Care Level 3: Additional Prescription Order Level 5: Emergency Room Visit Level 7: Life Threatening
Case Example #1: Question 17
What should be included in the note of the second claim?
Description of the education and monitoring
Description of the intervention Justification for the ECA selected B & C
Case Example #2 A 54 year old male presented to a pharmacy requesting a
refill of his medication (Drug A) to prevent gout attacks. He stated that he was having an acute gout flare and he did not feel the medication was helping.
The pharmacist educated the patient that this medication is used for maintenance therapy to prevent gout attacks and explained that the physician must be contacted to recommend a treatment (Drug B) for the current attack. The pharmacist contacted the doctor and recommended a treatment. The physician approved the new order.
The pharmacist educated the patient about the new medication and how to start the refill when the gout flare resolves. A monitoring call was scheduled for two days later. During the monitoring call the patient stated that his attack has resolved and he was doing much better with no questions, and was now taking the medication daily for maintenance.
Case Example #2: Question 1
How many Encounter claims should be filed as a result of Case Example #2? One Two Three Four
Case Example #2: Question 2
What is the Reason for the first claim?
Other Overuse Underuse Administration/Technique
Case Example #2: Question 3
What is the Action for the first claim?
Patient Education/Monitoring Prescriber Consultation Patient Consultation Patient Compliance
Consultation
Case Example #2: Question 4
What is the Result for the first claim? Therapeutic Success Altered Compliance Initiated New Therapy Altered Regimen/Changed Drug
Case Example #2: Question 5
What is the initial prescription information for the first claim? The medication to prevent gout
attacks (Drug A) The medication to treat gout
attacks (Drug B) A pain medication There is no initial prescription
information
Case Example #2: Question 6
What is the final prescription information for the first claim? The medication to prevent gout
attacks (Drug A) The medication to treat gout
attacks (Drug B) A pain medication There is no final prescription information
Case Example #2: Question 7
What is the frequency of therapy for the first claim? Acute Intermittent Chronic You do not need to select a
frequency of therapy
Case Example #2: Question 8
What is the ECA for the first claim?
Level 1: Improved Quality of Care Level 2: Drug Product Costs Level 3: Additional Physician Visit Level 5: Emergency Room Visit
Case Example #2: Question 9
What should be included in the note of the first claim? Description of the education and
monitoring Description of the intervention Justification for the ECA selected B & C
Case Example #2: Question 10
What is the Reason for the second claim? New/Changed Prescription Therapy OTC Therapy Needs Therapy Unnecessary Therapy
Case Example #2: Question 11
What is the Action for the second claim?
Comprehensive Medication Review (CMR)
Prescriber Consultation Patient Education/Monitoring Patient Compliance Consultation
Case Example #2: Question 12
What is the Result for the second claim? Therapeutic Success Initiated New Therapy Changed Drug Altered Regimen/Changed Drug
Case Example #2: Question 13
What is the initial prescription information for the second claim?
The medication to prevent gout attacks (Drug A)
The medication to treat gout attacks (Drug B)
A pain medication There is no initial prescription information
Case Example #2: Question 14
What is the final prescription information for the second claim?
The medication to prevent gout attacks (Drug A)
The medication to treat gout attacks (Drug B)
A pain medication There is no final prescription information
Case Example #2: Question 15
What is the frequency of therapy for the second claim?
Acute Intermittent Chronic You do not need to select a
frequency of therapy
Case Example #2: Question 16
What is the ECA for the second claim? Level 1: Improved Quality of Care Level 3: Additional Physician Visit Level 5: Emergency Room Visit See Previous Claim
Case Example #2: Question 17
What should be included in the note of the second claim? Description of the education and
monitoring Description of the intervention Justification for the ECA selected B & C
Case Example #2: Question 18
What is the Reason for the third claim?
New/Changed Prescription Therapy Suboptimal Drug Selection Adverse Drug Reaction Other
Case Example #2: Question 19
What is the Action for the third claim?
A. Comprehensive Medication Review (CMR)
Prescriber Consultation Patient Education & Monitoring Patient Compliance Consultation
Case Example #2: Question 20
What is the Result for the third claim?
Therapeutic Success Initiated New Therapy Changed Drug Altered Regimen/Changed Drug
Case Example #2: Question 21
What is the initial prescription information for the third claim?
The medication to prevent gout attacks (Drug A)
The medication to treat gout attacks (Drug B)
A pain medication There is no initial prescription information
Case Example #2: Question 22
What is the final prescription information for the third claim?
The medication to prevent gout attacks (Drug A)
The medication to treat gout attacks (Drug B)
A pain medication There is no final prescription information
Case Example #2: Question 23
What is the frequency of therapy for the third claim? Acute Intermittent Chronic You do not need to select a
frequency of therapy
Case Example #2: Question 24
What is the ECA for the third claim?
Level 1: Improved Quality of Care Level 3: Additional Prescription
Order Level 5: Emergency Room Visit Level 7: Life Threatening
Case Example #2: Question 25
What should be included in the note of the third claim?
Description of the education and monitoring
Description of the intervention Justification for the ECA selected B & C
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Congratulations!
This concludes Module/Encounter MTM Case Examples.